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My Daily Struggles: Psychotherapy of Schizoid Process 

My Daily Struggles 

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q Psychotherapy of Schizoid Process 

Transactional Analysis Journal, Vol. 31, No. 1, January 2001 


Schizoid process is one of the most ubiquitous personality patterns, 
but it is insufficiently discussed in the literature. This article offers a 
description of both the true schizoid and the more prevalent schizoid 
process that runs through various types and levels of functioning. 
Schizoid process and personality type are described, including the 
characterological organization, interpersonal processes, and 
developmental origins of schizoid process. Therapy of schizoid 
process is discussed in terms of presentation of the schizoid in 
psychotherapy, development of the therapeutic relationship, stages 
of therapy, and treatment suggestions and cautions. The schizoid 
process is important enough to warrant more attention than it 
currently receives, partly because, to some degree, everyone 
experiences some facets of it. Discussions about the schizoid process 
can clarify issues related to contact, isolation, and intimacy in 
relation to people with a variety of character styles who operate at 
levels of personal functioning ranging from normal neurosis through 
serious character disorders. True schizoids are also fairly common. 
These are individuals for whom the schizoid process is central to 
their dynamics and who fit the DSM-IV (American Psychiatric 
Association, 1994) diagnostic criteria. They tend to be quiet patients 
who do not cause much trouble or make many demands. If the 
therapist does not know about the schizoid process and how to work 
with it, such clients may well be in therapy for a long time without 
really dealing with their most basic issues. 

This article is a modified version of a keynote address given on 20 
August 1999 at the annual conference of the International 
Transactional Analysis Association in San Francisco. In this article I 
use the term "schizoid" to refer both to the true schizoid and to the 
patient who functions with significant schizoid processes or defenses 
but does not fit the full diagnostic picture. 

Presenting Picture of the True Schizoid 

The true schizoid usually presents as a loner, someone who is 
profoundly emotionally isolated, who has few close friends, who is 

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My Daily Struggles: Psychotherapy of Schizoid Process 

not very close even in "intimate" relationships, who drifts through 
life, and for whom life seems boring or meaningless. Schizoid 
patients usually show extreme approach-avoidance difficulties. They 
often come to therapy because of loss or threat of loss of a 
relationship or because of relationship difficulties at work. They 
frequently describe themselves as depressed and tend to identify 
more with the spaces between people than with interhuman 
connections. In therapy, as in many of their relationships, they tend 
to be present but not with vitality — that is, not "in their body" or 
with their feelings. Schizoid patients tend to come to therapy 
regularly but do not appear to be engaged emotionally. A common 
reaction of the therapist in response to a schizoid patient is to 
become sleepy, even if he or she does not have this reaction with 
other patients. There is so little human connection during sessions 
that it is like not having enough oxygen in the room. The first time 
this happened to me was with a patient I liked. I thought perhaps I 
was getting sleepy because I saw her right after lunch, so I changed 
her hour. But that was not the problem. In fact, I never get sleepy 
with patients — except occasionally with a schizoid patient. 

The Existential Terror Underneath 

To people with schizoid character organization, real human 
connections are terrifying. In their fantasy life and their behavior, 
these individuals try to live as if in a castle on an island where they 
are totally safe. The main feature of this isolation is a denial of 
attachment and the need for other people. Of course, living that 
way brings on another terror— the terror of not being humanly 
connected. If their tendency to defend themselves by isolating were 
to be fully realized, they would not be connected enough to 
maintain a healthy ego. Schizoid individuals have to struggle to 
maintain their human existence as individual persons. The human 
sense of self and good ego functioning cannot develop and be 
sustained without interpersonal engagement, but schizoid isolating 
defenses attenuate the interpersonal bond to the point of 
endangering ego development and maintenance. Often schizoid 
people will create in their fantasy life the satisfaction or safety they 
lack in their experienced interpersonal world. They also have human 
connections in safe contexts (e.g., at a geographical distance), and 
disguised longings are often found at a symbolic level (e.g., in 
dreams and daydreams). One frequent symbolic wish is to return to 
the womb, which is seen as a state of oneness and safety. But, if 
that were possible, it would make sustained human identity 
impossible since it would exclude interpersonal contact. 

Contact and Contact Boundaries 

To understand the importance of the schizoid process in all human 
functioning, we need to consider the concepts of contact and 
contact boundaries. Contact is the process of experiential and 
behavioral connecting and separating between a person and other 
aspects of his or her life field. The contact boundary has the dual 
functions of connecting and separating the person and his or her 
environment (including other people), just as a fence has the dual 

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My Daily Struggles: Psychotherapy of Schizoid Process 

function of connecting and separating two properties. These dual 
functions involve movement along a continuum between the two 
poles or functions of connecting and separating. The connecting 
process involves a closing of the distance between people, a 
receptiveness or openness to the outside — and especially to other 
people — with the boundary becoming porous so that one takes in 
from and puts out to others. The separating process involves 
increasing distance, closing off the boundary, being alone and not 
taking in, with the boundary becoming less porous and closed to 
exchange; at the extreme, the boundary becomes closed, like a wall. 
People need both connecting and separating. All living creatures 
need to connect with their environment to grow. J ust as we can only 
survive physically by taking in air and water from the environment, 
human psychological development and maintenance also requires 
connection with the environment, especially with other people. 
People can only grow and flourish by connecting to the interhuman 
environment. At the extreme end of the connection pole is merger, 
enmeshment, and a loss of separate existence, will, need, and 
responsibility; such total connection means death by merger, a 
disappearance of autonomous existence. Physically it means merger 
with the environment; psychologically it means a loss of individuation 
and separate existence. Human existence requires some degree of 
experienced separation from the environment. So we see that 
oneness can be healthy or unhealthy, just as separating can be. 
Intimacy is a healthy form of oneness, whereas a spiritual retreat is a 
healthy example of separation from ordinary contact. Ideally, the 
movement between contact and withdrawal is governed by emerging 
need. We become lonely, we need to connect; we move into 
intimacy, momentary confluence, or ongoing commitment. Then we 
move away from connecting with the other to be with self, to rest 
and recover, to center, or to find serenity. Thus we connect to the 
point of satisfaction of need, then change focus according to a new 
emerging need. We separate from a particular contact when 
withdrawal or different contact is needed. However, in health, a 
person withdraws from contact while sustaining a background sense 
of self connected with other people and the universe. This flexible 
movement between close connection and separation preserves the 
sense of being humanly connected. It is unhealthy when this 
flexibility is lost and either separation or connection becomes static 
because movement in and out of contact according to need is 
diminished or restricted. At one unhealthy extreme the individual 
separates and isolates to the point of losing a sense of being 
humanly bonded. Isolating in this way and to this degree is crucial to 
understanding the schizoid process. For schizoids, the process of 
separating with underlying connectedness and connecting while 
maintaining autonomy is foreign. Their lives are marked by the 
profoundly frightening and disturbing fact of separating without 
maintaining a sense of emotional connectedness and without a 
developed ability to connect again. They do not connect to others 
with much hope of being met and lovingly received. Schizoids do not 
believe they can be loved, and they fear that even if a relationship 
is established, the intimate connection means losing autonomy of 
self and other. Even feeling the need to connect would, in either 
case, be painful and/ or frightening. It is dangerous to move into .html[ 16/01/20 13 23:42:38] 

My Daily Struggles: Psychotherapy of Schizoid Process 

intimate connection if you cannot separate when needed. If you 
think you are going to be caught up, devoured, or captured in the 
connection, it is terrifying to move into intimate contact. On the 
other hand, if you do not feel connected with other people, 
especially if you do not believe you can intimately connect again, 
the separation or isolation is both painful and terrifying. Without 
movement one is fixed, stuck, stagnant, and unable to grow. Being 
stuck in any position on the continuum of connection and separation 
— which is the case when the schizoid process is operating — involves 
a degree of dysfunction, with some needs not being met. Being stuck 
in an isolated position, a connected position, or a middle position 
between intimacy and isolation are all problematic. Being fixed in a 
middle position is common in the schizoid process: The person is 
neither truly alone nor truly with another. This immovable position 
between connecting and separating is a compromise to avoid the 
terror of being completely alone in the universe, on the one hand, or 
of being threatened by engulfment, enmeshment, attack, and 
rejection, on the other. 

Twin Existential Fears 

The typical childhood of the schizoid patient is marked by the 
experience of too much or too little human connection. Too little 
refers to a lack of warmth and connectedness and a sense of 
emotional abandonment; too much refers to intrusive parenting that 
emotionally overrides the capability of the infant or young child and 
causes him or her to isolate or dissociate to survive. Sometimes the 
abandonment and intrusion alternate. Given what we know about 
the importance of flexible movement between connecting and 
separating for the growth and well-being of the individual, it is easy 
to understand how the typical childhood experiences of the schizoid 
leave him or her with deep-seated, often unconscious feelings of 
merger-hunger, on the one hand, and simultaneous fear of 
entrapment and suffocation on the other. These lead to universal 
twin fears that are fundamental to the schizoid process: the panic or 
terror of contact engulfment/ entrapment and the panic or terror of 
isolation. These are particularly intense and compelling for the 
schizoid, who experiences them at the existential level of survival or 
death. Because the schizoid splits connecting and disconnecting, thus 
losing easy movement between them, he or she is faced with the 
threat of becoming stuck at one pole or the other. Therefore, 
schizoids think of relationships mostly in terms of potential for 
entrapment, suffocation, and bondage. They do not trust that they 
will not devour the significant other or be devoured. They do not 
believe that separation will happen as needed, and thus they do not 
feel safe to be intimately connected. Of course, the danger of 
entrapment comes in large part from their own hunger for oneness 
and fear of abandonment, and the connection between their own 
merger-hunger and the fear of entrapment is mostly not in their 
conscious awareness. Many schizoid patients start treatment with the 
expectation that they will be devoured or abandoned in therapy. 
Although they may be conscious of this fear early in the process, the 
extent of the dual fears and the connection to their merger-hunger 
is usually not in awareness until much later. Until then the denial of .html[ 16/01/20 13 23:42:38] 

My Daily Struggles: Psychotherapy of Schizoid Process 

both attachment and the need for intimacy predominates. Their own 
merger-hunger is projected onto others as a way of avoiding the 
awareness by attributing it to someone else. Sometimes these 
anticipations or perceptions are a projection, although they can also 
be accurate. Total isolation or abandonment is like death, especially 
for the young child. Part of the schizoid process is terror— although 
not necessarily conscious— of a triple isolation: isolation from 
others, isolation of the core self from the attacking self, and 
isolation within the core self. A significant part of the schizoid 
process is a splitting between attacking selves and core selves. At a 
deeper level there is also a kind of isolation between aspects of the 
core self. In gestalt theory this is conceptualized as a boundary 
between parts of the self that interferes with the boundary between 
self and other. Experiencing the self in a vacuum means loss of the 
sense of self as a living person. The resulting loneliness is profound. 
It is real progress in therapy when the true schizoid patient is able to 
experience loneliness and the desire for connection. 

The Schizoid Compromise: The In-and-Out Program 

One solution to the problem of avoiding complete deadness of self 
from lack of human connection while also avoiding the threat to 
existence and continuity of self from intimate contact is what 
Guntrip (1969) called "the schizoid compromise" (pp. 58-66). This 
refers to not being in but also not being out of engagement with 
other persons or situations. An image that I think I borrowed from 
Guntrip seems apt here: "How do porcupines make love? Very 
carefully." There are several common "very careful" patterns of the 
schizoid compromise. For example, a writer is too lonely to write in 
his apartment, so he goes to a coffee shop with his laptop computer 
and manuscript. There he is not really connected with anybody, 
especially since he does not give out signals that he wants to talk to 
anyone, but he is not alone either. Another example is a man from 
Los Angeles who has a relationship with a woman who lives in New 
York City. He can have a weekend connection without the risk of 
losing himself or being trapped in the relationship. When Monday 
morning comes, he will be thousands of miles away in Los Angeles 
again while she stays in New York. Another type of schizoid 
compromise involves the person repeatedly pulling out of 
relationships before making a commitment. Such individuals go 
through a series of relationships, always finding a reason why they 
cannot con-tinue. A similar pattern is having multiple lovers at the 
same time; the person engages one part of the self with one partner 
and another part of the self with someone else. One typical 
configuration is having a sexual relationship with a lover, but without 
companionship and building a life together, while maintaining a 
primary but nonsexual relationship with a spouse. Sometimes 
individuals who show this pattern will say something like, "Gee, why 
can't I get this together?" or ask "Why can't I get a woman who has 
both?" Such patterns illustrate a core pattern: the schizoid is 
impelled into relationship by need and driven out by fear. When 
faced with someone with whom they might be intimate, they find it 
both exciting and frightening. They are afraid that they will devour 
their lovers with their need or that the lover will be devouring, .html[ 16/01/20 13 23:42:38] 

My Daily Struggles: Psychotherapy of Schizoid Process 

deserting, or intrusive. They might lose their individuality by 
overdependence and merger-hunger or lose the relationship by being 
too much, too toxic, or too needy. The solution to these dilemmas is 
Guntrip's schizoid compromise— to remain half in and half out of the 
relationship, whether in the form of marriage without intimacy, 
serial monogamy, or two lovers at the same time. Needs and fears 
will often be either denied or acknowledged in an i ntellectual ized 
manner. Frequently such individuals will oscillate between longing 
for the intimate other and rejecting him or her, or they may stay in 
a stable halfway position not able to commit to being fully in the 
relationship or discontinuing it. They are tempted repeatedly to 
leave the relationship and live in a detached manner, but often they 
return again and again. When touched emotionally or feeling 
intimate, the schizoid may become annoyed, scared, fault finding, 
and disinterested. Meaningful contact with another leads to crisis, 
and crisis leads to abolishing the relationship. They cannot live fully 
with the other, but they cannot live without the other either. Being 
with threatens death-level confluence; being alone threatens death- 
level isolation. So the schizoid lives suspended between his or her 
internal world and the external world without full connection with 
either. Suspended in the death-level conflict between total isolation 
and being swallowed up, these individuals often feel tired of life and 
the urge for temporary death. This is not active suicide, just 
exhaustion from living a life with insufficient nourishment. 

Themes in Therapy 

The discussion so far points out the major themes that emerge in 
therapy with schizoid individuals: isolating tendencies, denial of 
attachment, themes of alienation, and feelings of futility. 

Isolating tendencies. 

Since being close causes schizoids to feel claustrophobic, smothered, 
possessed, and stifled, they often turn inward and away from others. 
Thus commitment to relationship is very hard. They treat their 
internal world as real and the external world as not real. They often 
have a rich fantasy life and tepid affective contact with others. In 
isolation they often fantasize about merger or confluence as 
something to be longed for or to feel panicked about— or both. In 
actual or fantasy contact they fantasize about isolation either as a 
positive way of getting their own space or as something terrifying — 
or both. Schizoids manipulate themselves more than they interact 
with the environment. Such individuals usually appear detached, 
solitary, distant, undemonstrative, and cold ("cold fish"). They do 
not seem to enjoy much and have few if any friends. They appear to 
live inside a shell, and in most relationships (including in therapy), 
those with whom they are relating have the sense of being shut out 
while the schizoid is shut in, cut off, and out of touch. What is not 
always obvious with these individuals is that they still have a 
capacity for warmth, in spite of the schizoid process. This may come 
out in various ways, for example, with pets but not with people. I 
remember one schizoid woman who said that "the only people I trust 
are dogs," which she did not mean as a joke. With such patients the .html[ 16/01/20 13 23:42:38] 

My Daily Struggles: Psychotherapy of Schizoid Process 

therapist needs to be sensitive to subtle shifts in order to pick up 
and gauge emotional reactions. This is especially true since schizoids 
often show a low level of manifest interest and affective energy, 
appearing to be absent minded and mentally half listening. Most 
often schizoids will express a desire to be free of any impingement 
or requirement to do anything. In a relationship they will often talk 
about how they want to be able to go out and not have to face any 
limitations. At these times the desire to connect is usually out of 
awareness. However, the schizoid process involves more than the 
simple isolating behavior of a shy or anxious person, more than social 
anxiety, obsessive compulsive behavior, or intellectualizing, although 
a schizoid character pattern may underlie any of these other 
isolating patterns. The issues of the schizoid involve life-threatening 
levels of existential vulnerability. Because this profound vulnerability 
makes the relationship with the therapist deeply terrifying, it takes a 
long time for the therapeutic relationship, including trust, to 
develop. It should be noted that the cognitive descriptions in this 
article provide a kind of a map for the therapist, but one that only 
points the way to work at a feeling level. Awareness and working 
through with these individuals requires developing a trusting 
relationship; no fundamental change can happen with the schizoid on 
a purely cognitive basis. 

Denial of attachment. 

For children who later become schizoid adults, one way of coping 
with a world that is too big, menacing, intrusive, unresponsive, 
and/ or abandoning is to deny any need, weakness, and dependency 
and to promote the illusion of self-sufficiency. They learn to survive 
by living without feeling dependence, desire, need, or fear. The 
schizoid is especially trying to avoid burdening and killing parents 
with his or her needs. Schizoids avoid awareness of attachment in 
various ways. The most common is splitting off or disassociating from 
needs and feelings that are overwhelming. Conformity can also be a 
means of avoiding awareness of need and fear as can obsessive- 
compulsive self-mastery, addiction to duty, or service to others. One 
can avoid attachment needs by being regulated by rules and 
regulations rather than by vitality affect, or by conforming and 
serving, thus forming a false self that consists of a conventional, 
practical pseudo-adult who masks a frightened inner child. Denial of 
attachment results in shallow relations with the world. Compulsive 
activity, compulsive talking, and compulsive service to causes can all 
mask a shallowness of affective connection. Some people who appear 
to be extroverted are actually schizoid in their underlying character 
structure. In the extreme, the schizoid's denial of attachment results 
in his or her being mechanical, cold, and flat to the point of 
depersonalization; the individual loses a sense of his or her own 
reality and experiences life as unreal and dream-like. Of course, not 
all schizoids depersonalize to this extent. Schizoids often may 
deflect the importance or impact of praise and criticism as 
protection against attack, disapproval, disappointment, and so on. 
Although they strive to feel and appear unaffected by praise and 
criticism, they are actually sensitive, quick to feel unwanted, and 
suffer from a deep underlying shame (Lee& Wheeler, 1996; Yontef, .html[ 16/01/20 13 23:42:38] 

My Daily Struggles: Psychotherapy of Schizoid Process 

1993). Their self-representation is always a shameful sense of self as 
being defective, toxic, and undesirable. They live internally as if 
they were always deserted because of their own defect. They are 
especially contemptuous of their own "weak (needy) self." When the 
need they have been denying starts to emerge into awareness, 
schizoids experience intense shame. In fact, shame is a fundamental 
process for schizoids. They are easily shamed, although that is not 
always obvious because they deny that they are attached or that 
they need anything. When they feel safe enough to start exploring 
their shame, they manifest a great deal of loathing for their needy 
self. However, if the therapy is confrontive (e.g., in the way 
encounter groups and some confrontive gestalt therapists used to 
be), demands quick change, or is insensitive to issues of shame, 
these feelings will not emerge because the patient will not 
experience the necessary fundamental trust in the therapeutic 

Themes of alienation. 

Schizoids feel so alienated and different from others that they can 
experience themselves literally as alien — as not belonging in the 
human world. I have a patient from Argentina who quoted a saying in 
Spanish that describes her experience: She feels like a "frog who's 
from another pond." In their alienation, these individuals cannot 
imagine themselves in an intimate relationship. The people world 
seems strange and frightening, even if also desirable. When they see 
couples being intimate, they are often mystified: "How do they do 
that?" No matter how they force themselves to date or to meet new 
people, they cannot imagine themselves in a sustained intimate 
relationship. This leads to the fourth theme. 

Feelings of futility. 

The schizoid experiences loneliness, futility, despair, and depression, 
although the latter is somewhat different from neurotic, guilt-based 
depression. Both are comprised of dysphoric affects and an avoidance 
of primary emotions and full awareness. However, neurotic 
depression has been described as "love made angry. "That is, the 
depressed person feels angry at a loss followed by sadness and 
broods darkly against the "hateful denier." This aggressive emotional 
energy then gets turned against the self. In contrast, schizoid despair 
has been described as "love made hungry." The person experiences a 
painful craving along with fear that his or her own love is so 
destructive that his or her need will devour the other. The schizoid 
feels tantalized by the desire, made hungry, and driven to withdraw 
from the "desirable deserter." The deep, intense craving is no less 
painful because it is consciously renounced or denied. In ordinary 
depression the person has a sense of the self as being bad; usually 
he or she feels guilty, horrible, and paralyzed. The schizoid, on the 
other hand, feels weak, depersonalized, like a nonentity or a nobody 
without a clear sense of self. Guntrip said that people much prefer 
to see themselves as bad rather than weak. They will typically refer 
to themselves as depressed more readily than weak, bad rather than 
devitalized, futile, and weak. Guntrip (1969) called the depressive .html[ 16/01/20 13 23:42:38] 

My Daily Struggles: Psychotherapy of Schizoid Process 

diagnosis "man's greatest and most consistent self-deception" (p. 
134). He went on to say that psychiatry has been slow to recognize 
"ego weakness," schizoid process, and shame. "It may be that we 
ourselves would rather not be forced to see it too clearly lest we 
should find a textbook in our own hearts" (p. 178). Fortunately, I 
think in the last few years there has been a real opening in 
therapeutic circles to recognizing relationship and shame issues 
present in the therapist as well as in the patient (Hycner & J acobs, 
1995; Yontef, 1993). 

Healthy Development 

The self can only experience itself in the act of experiencing 
something else — and being experienced. Cohesive, healthy self- 
formation depends on contact with the mothering person that is 
neither too little nor too much. From birth, infants are equipped to 
be both separate from and connected with others. Stem's (1985) 
research confirmed that from the beginning infants know themselves 
and connect with the human environment. For their maturational 
potential to develop, infants must be welcomed into the world and 
supported in being themselves and being connected. This support 
starts with the mother restoring the connection severed by birth. 
The infant needs to be made to feel that he or she belongs in the 
world of people. Through a dependable mother and infant 
relationship, the infant learns that he or she is not emotionally alone 
in the world even when physically separated. This support for 
connection and separation is needed throughout infancy and 
toddlerhood. Ideally, the infant/ child learns that he or she can be 
alone in the presence of the mother and thus in intimate relations 
with others. In this way children learn that they can have privacy 
and self-possession without loss of the other, that they can be 
physically separate or have their own feelings and thoughts in the 
presence of the parent and still feel connected and feel connected- 
with when they have needs and feelings. The child can be alone in 
outer reality because he or she is not alone in inner reality. The 
development of these capacities depends on early parental 
experience, the development of object constancy, and so forth. 

Schizoid Development 

Unfortunately, the course just described is quite unlike the early 
experience of the schizoid, whose childhood tends to be marked 
alternately by experiences of intrusion and being overwhelmed, on 
the one hand, and feeling empty and alone in the universe, on the 
other. The schizoid then uses worry, fantasy, and isolation to protect 
against these experiences. Although nature and mother arouse 
powerful emotional needs in the child, if there are either insufficient 
warm, loving responses or an excess of intrusive, overwhelming 
responses, the need only increases, and the child experiences painful 
deprivation or unsafe feelings as well as anxiety at separation 
and/ or connection. A deep intimacy-hunger grows in the child. The 
schizoid's early experience is that mother is not reliable, usually 
because she is alternatively intrusive and abandoning. Mother not 
only cannot tolerate, contain, and guide the child's affects (e.g., .html[ 16/01/20 13 23:42:38] 

My Daily Struggles: Psychotherapy of Schizoid Process 

need, anger, exuberance, even love), she finds them threatening and 
overwhelming and treats them as toxic. These mothers usually 
become overwhelmed because of their own depression, life situation, 
or characterological issues; often they do not have the support they 
need to meet the child in intensive affective states and to stay with 
him or her until the affect has run its course. Clearly, the problem is 
with the mother, not with the child. However, the infant or child's 
experience is that his or her life forces and vitality appear to kill 
mother — or at least the connection to and relationship with mother. 
If a young child has a tantrum and mother withdraws to her room for 
three days, the child's reality is that he or she has emotionally killed 
mother. And, of course, killing mother would make the infant's life 
impossible as he or she cannot live without a parent. The legacy for 
the child is that his or her life force threatens mother, which is 
equivalent to the child experiencing that "my life threatens my life." 
Anything from within, even something good, turns bad and 
destructive with exposure. The only hope is to keep everything inside 
and thus invisible. The child must, at all costs, avoid causing total 
emotional abandonment by or intrusion and annihilating counter- 
attack from mother. Therefore, the child suffers isolating himself or 
herself to avoid an even more devastating deprivation — the loss of 
the mother and the child's relationship with her. Unfortunately, this 
leaves the child with a huge hunger that cannot be satisfied, a 
hunger that is projected onto the mother, who is then seen as 
devouring. And a mother who actually does devour makes this even 
more real and frightening. 

Splitting the Self 

An important part of how the child copes with this situation is by 
splitting the self. Survival is achieved by relating to the world with a 
partial self or "false self," one that is devoid of most significant 
affect and relates on the basis of conforming to others' requirements 
rather than on the basis of organismic experience. Guntrip (1969) 
used the phrase "the living heart fled" (p. 90) to describe the 
situation in which the vital energies, emotions, and vitality affects 
are held inside, leaving an empty shell to interact with others and to 
direct human relations. This schizoid pattern creates external 
relations that are not marked by warm, live, pulsing feelings. 
Instead, when interpersonal nurturance is available, schizoid 
individuals fear a loss of self from being smothered, trapped, or 
devoured. When strong desire or need is aroused, they tend to break 
off the relationship. Hatred is often used to defend against love with 
its dangers and disappointments, a pattern that starts in early 
childhood. However, what happens to the lively emotional energy 
that is held in? And how does the schizoid stay sufficiently related to 
people to support the survival of the self? One key process is the 
development of internal rather than interpersonal dialogues. Instead 
of someone with a relatively cohesive sense of self interacting with 
others, there is a sense of self in which aspects of personality 
functioning are split off from each other. The most commonly 
encountered manifestation of this in psychotherapy is the split 
between an attacking self and the "core" or "organismic" self. When 
the organismic self shows characteristics of being in need or .html[ 16/01/20 13 23:42:38] 

My Daily Struggles: Psychotherapy of Schizoid Process 

emotional, the attacking self makes self-loathing, judgmental 
statements about being "weak" or "needy." One might characterize 
this as attacking and shaming the organismic self, which it calls the 
"weak self. "The person often identifies with the attacking self and 
thinks of his or her own love as so needy that it is devouring and 
humiliating. To the degree that the person's contact is between 
parts of the self rather than a relatively unified self in contact with 
the rest of the person/ environment field, the person is left with a 
deep and painful intimacy-hunger (often denied), dread, and 
isolation. The internal attack is usually not only on the self that is 
needy, hungry, and weak, but also on the self of passion and bonding 
— even happy passions. Within the core self there is another split, 
which I will only consider briefly. This split is between the self (or 
the self-energy) that connects and fights with the attacking self and 
the core energy that has an urge to isolate even more, to go back to 
the womb. The retreat from the internal self-attack is designed to 
protect the core life energy, which is kept isolated in the 
background to protect it. It is a fight for life. There are a couple of 
other things that occur because of this process that I have not yet 
mentioned. One is that, as part of schizoid dynamics, cognitive 
processes are often used in the service of feeling humanly connected 
while remaining isolated rather than in preparation for interpersonal 
contact. Self-attack is an internal dualism that divides the person 
into at least two subselves. When the self-attack is on the feeling 
self, it results in shame, humiliation, and psychological starvation. It 
creates the defect of a divided rather than unified self and makes 
the life energy (i.e., feelings) a sign of being defective. It creates a 
sense that since I feel, want, and need, therefore I am unworthy of 
love and respect. So it is not surprising that schizoids often attempt 
to annihilate or master their feelings of need, sometimes in a 
sadomasochistic way. For them, self-attack is not directed toward 
their "doing"; it is an attack or attempted annihilation of the "being." 
However, being and being-in-relation are inseparable. The sense of 
self only develops in relationship, not in a vacuum. Feeling with and 
feeling for other persons — and being felt for by them — is vital for a 
healthy sense of self. Shared emotional experience is a part of 
learning to identify and identify with the self and to identify with 
bonding with others. Because of their isolating and denial of 
attachment, schizoids often operate without a sense of being — the 
empty shell experience. This "doing" without a sense of "being" leads 
to a sense that being or life is meaningless. Schizoids usually feel 
this way, although they often attribute it to a particular activity 
being meaningless rather than to their own process. Even the core 
self — in reaction to the top-dog, critical self — is split. There is an 
engaged, contact-hungry core self that does battle with the top-dog 
self, which can manifest in sado-masochistic and bondage and 
discipline fantasies. In contrast, the passive, isolating core self is 
regressive and imagines going back to the womb. It is this self that is 
in danger of losing human connectedness; it fears existential 
starvation, loss of ego or sense of self, depersonalization, being 
alone in a vast, empty universe, even death. These fears can become 
known during quiet times, which may make calm, peace, quiet, 
sleep, or meditation frightening. The unfinished business of 
schizoids, their most central life script issue, centers on the struggle .html[ 16/01/20 13 23:42:38] 

My Daily Struggles: Psychotherapy of Schizoid Process 

to make "bad introj ects" into "good introj ects. " However, this usually 
does not succeed easily. The bad introj ect usually stays rejecting, 
indifferent, and hostile until very late in therapy. While the therapist 
may think that progress is being made as some of these issues are 
uncovered, the schizoid patient often experiences only intensified 
self-loathing. Frustration and failure trigger the unfinished business 
and the rest of this negative script, including isolating defenses, 
retroflected anger and rage, strong defense of the negative sense of 
self, harsh self-attacks, and shame. It takes a great deal of patience 
and a long time to work through these issues. 

Working with Schizoids and the Schizoid Processes in 

The Paradoxical Theory of Change. 

The gestalt concept of the paradoxical theory of change (Beisser, 
1970) says that the more you try to be who you are not, the more 
you stay the same. That is, true change involves knowing, identifying 
with, and accepting yourself as you are. Then one can experiment 
and try something new with an attitude of self-acceptance. This 
contrasts with attempts to change that are based on self-rejection 
or trying to make yourself into someone you are not. Working in the 
mode of the paradoxical theory of changes promotes self-support, 
self-recognition, and self-acceptance as well as growth from the 
present state by experimenting with new behavior. This 
experimentation can be either the spontaneous result of self- 
recognition and self-acceptance or on the basis of systematic 
experimentation. The therapist's task is to engage with the patient in 
a way that is consistent with this paradoxical theory of change. With 
schizoids, this means engaging with the patient at each moment and 
over time without being intrusive or abandoning, without sending the 
message that the patient must be different based on demands or 
needs of the therapist or the therapist's system. While many 
therapists might endorse this in the abstract, often their nonverbal 
communication creates pressure for the patient to change based on 
willpower, conformity, or as a direct result of the therapist's 

The Dialogic Therapeutic Relationship. 

Some of the principles guiding work from this perspective are the 
characteristics of dialogue according to Buber's (1965a, 1965b, 1967; 
Hycner & J acobs, 1995) existential theory. They include: inclusion, 
confirmation, presence, and surrendering to what emerges in the 
interaction. Buber's (1965b, p. 81; 1967, p. 173) term "inclusion" is 
similar to the more common term "empathic engagement." Inclusion 
involves experiencing as fully as possible the world as experienced by 
another— almost as if you could feel it within yourself, within your 
own body. Buber (1965b) called this "imagining the real" (p. 81), that 
is, confirming the other's reality as valid. Both inclusion and empathy 
involve approximation; however, inclusion calls for the therapist's 
more complete imagining of the other's experience than does 
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My Daily Struggles: Psychotherapy of Schizoid Process 

exercise; it is an emotional, cognitive, and spiritual experience. It 
involves coming to a boundary with the patient and joining with the 
patient's experience, but it also requires the therapist to remain 
aware of his or her separate identity and experience. This allows for 
deep empathy without confluence or fusion. Inclusion, or imagining 
the patient's reality, provides confirmation of the patient and his or 
her experienced existence. It involves accepting the patient and 
confirming his or her potential for growth. Such confirmation does 
not occur in the same way when the therapist needs the patient to 
change and thus aims at a conclusion rather than meeting the 
patient with inclusion. A dialogic approach requires genuine, 
unreserved communication in which the therapist is present as a 
person — that is, authentic, congruent, and transparent — rather than 
as an icon of seamless good functioning. The therapist cannot 
practice this kind of therapy and also be cloaked in a psychological 
white coat. He or she must be present by connecting with the 
patient's feelings as well as by acknowledging his or her own flaws, 
foibles, and mistakes. The dialogic therapist must trust in and 
surrender to what emerges from the interaction with the patient 
rather than aiming at a preset goal. This approach recognizes, 
centers on, tolerates, and stays with what is happening as the 
therapist practices inclusion and thus focuses on present experience 
and moment-to-moment, person-to-person contact. In a sense, 
progress is a by-product of a certain kind of relating and mindfulness 
rather than something that is sought directly. The therapist 
relinquishes control and allows himself or herself to be changed by 
the dialogue just as the patient does. As a result, truth and growth 
emerge for both. 


Attitudes are often communicated not by the text of what the 
therapist says, but by the subtext or how things are said. Nonverbal 
cues have an especially powerful influence on schizoid patients, even 
if neither they nor the therapist are consciously aware of them. For 
example, a gesture, tone, or glance will often trigger a shame 
reaction in a patient without the therapist intending to do so and 
without either the therapist or the patient being aware of the 
process (Yontef, 1993). And even when this operation (i.e., the 
effect of the subtext) is in awareness, it may not be expressed or 
commented on. Although they may appear to be distant and only 
vaguely present, schizoid patients (and many other patients as well) 
are exquisitely sensitive to nuances of abandonment, intrusion, 
pressure, judgment, rejection, or pushing— in fact, to any message 
or subtext that says they are not OK as they are. Such messages are 
not only contrary to the paradoxical theory of change, but they also 
trigger unfinished business from painful childhood experiences of 
rejection and/ or intrusion. Sometimes I have tried to encourage a 
patient to feel better, to convince the self-loathing patient that he 
or she is not loathsome. By doing so, I inadvertently sent the 
message that the patient's feelings and sense of self were so painful 
that I as a therapist could not tolerate them. This was a repeat of 
the message the patient received from infancy: You are too needy, 
too much of a bother. When you as the therapist have a view of the .html[ 16/01/20 13 23:42:38] 

My Daily Struggles: Psychotherapy of Schizoid Process 

patient that is more positive than he or she has, the thing that you 
hear the most from the patient is, 'You don't understand." I still hear 
that occasionally, and I have been working with these dynamics for 
along time. In such cases, good intentions create disruptions in the 
contact between therapist and patient and an impediment to 
working through. (For a poignant example of this process, see Hycner 
& J acobs, 1995, p. 70.) I find it agonizing when patients I like hate 
themselves and describe themselves as loathsome, something totally 
contrary to how I and others (e.g., group members) experience 
them. For example, I have a bright schizoid patient who makes 
excellent comments in the group, comments that other patients 
appreciate and from which they benefit. But his self-description is, 
"I'm stupid," which for him is an untouchable reality. Attempts to 
induce him to take in the views of others and thus modify his view of 
himself have proved predictably futile. When people say they like 
him, think he is smart, or appreciate his remarks, his response is 
usually, 'You don't understand." I eventually said, in effect, 'You're 
right, I dont understand, your reality is that you are stupid." As I 
stopped fighting with him about his negative sense of self, deeper 
work started. Instead of pretense, I began to see more continuity of 
thematic work. In general, when the patient tells me that I do not 
understand, he or she is right. As the therapist you do not have to 
agree with the patient's viewpoint, but it is important to realize the 
patient's reality is as valid as the therapist's. Moreover, you cannot 
talk the patient out of his or her reality even if you believe it is 
acceptable to do so. Rather, the task is to connect with and tolerate 
the patient's experience so that he or she can learn to tolerate it — 
and then to grow beyond it according to the paradoxical theory of 
change. The "friendly" message of persuasion is actually an attempt 
to get the patient to change his or her perception, belief, 
experience— that is, to be different. If the patient is in despair, and 
the therapist works to get the patient not to feel despair, whose 
need is being served — the patient's or the therapist's? Can the 
therapist stand to stay in emotional contact as the patient 
experiences despair, depression, hopelessness, shame, and self- 
loathing? If the therapist cannot or will not stay with the patient's 
experience, he or she gives the patient the message once more that 
the patient's experience is too much to bear. This is like demanding 
a false self, and it triggers shame and reinforces the childhood 
script. The most important thing the therapist can do with schizoid 
patients is to work patiently and consistently to inquire about and 
focus on the patient's experience, on what it is like to live life with 
the subjective reality of being stupid and loathsome. This approach 
is most useful when combined with careful attention to subtle signs 
of disruptions in the contact between therapist and patient. 
Although schizoid patients will not tell you about them, you can see 
subtle signs of connection and disconnection if you are observant. 
Often the latter indicate that subtext (nonverbal signs from the 
therapist) have triggered a shame reaction. This is rich material if 
the therapist is willing to take the initiative to explore it. The same 
holds true when the patient has a different view of you, the 
therapist, than you have of yourself. If you honor the patient's 
experience as one valid reality, not the reality, you can explore the 
discrepancy between your "reality" and the patient's "reality" and .html[ 16/01/20 13 23:42:38] 

My Daily Struggles: Psychotherapy of Schizoid Process 

thus be consistent with the principles of dialogue, phenomenology, 
and the paradoxical theory of change. Working with this attitude 
offers growth for both patient and therapist. 


Schizoid patients are amenable to creative approaches that center 
on their experience, on contact, and on what emerges in the 
therapeutic relationship rather than on programs that try to get the 
patient somewhere. This can be maximized by identifying schizoid 
themes as they emerge rather than trying to formulate them 
according to a preset plan. If you show interest and inquire about 
the themes as they emerge, you do not need elaborate formulations 
to explain to the patient 

about his or her process or life script. Insight will emerge from the 
interaction when the therapist follows these basic principles. 
Although this may seem to take a long time, in the end it is more 
effective, safer, and no lengthier than approaches that appear to 
obtain a quicker cognitive understanding. Working through — that is, 
destructuring and integrating core processes — requires identifying 
and staying with feelings as the patient explores his or her 
experience. It involves feeling the affect and is, of necessity, more 
than cognitive and/ or verbal. The therapist must be able to 
experience with the patient the feeling of the empty shell, the core 
self, and the critic and to work with these feelings as they emerge 
and naturally evolve. It means feeling the inner child's painful 
hunger, terror, and need for the defense and how, when, and why it 
worked. It means feeling the experience of being an alien. Such 
working through requires more intensive work over time than therapy 
that is only palliative. Any cognitive identification of a theme before 
the patient can feel it is, at best, preparatory for deeper work, work 
based on the patient's felt sense of self and others. An interpretation 
is only valid when it is confirmed by the patient's felt sense of it. A 
cognitive identification before the patient can feel it lacks the 
patient's felt sense as a means of confirming or disconfirming the 
therapist's interpretations. The cognitive focus is often a barrier to 
deeper work based on a felt sense. The schizoid needs the therapist 
to be able to contact the hidden core self without being intrusive. 
This requires much sensitivity and awareness of the process so that 
openings can be found where the therapist and patient can discover 
a way to symbolize the very young, primitive, preverbal sentiment of 
the inner core self. It also requires that the therapist be willing and 
able to admit errors and counter-transference so that breaches in 
the therapist-patient relationship can be healed. A woman who 
wants to marry and raise a family but who relates to men using the 
schizoid compromise is not likely to benefit from either an emphasis 
on contact skills and relationship discussions that prematurely 
consider themes before they emerge in the therapy or a therapy in 
which the therapist does not understand the schizoid process. A man 
who says he wants intimacy but is always unavailable, critical, busy, 
or too impatient is in the same predicament. Treatment must 
proceed step by step by exploring issues as they emerge with a 
therapist who is informed by an understanding of the schizoid 
process. For example, a man in a relationship keeps asserting that he .html[ 16/01/20 13 23:42:38] 

My Daily Struggles: Psychotherapy of Schizoid Process 

wants his freedom. Inquiry and mental experiments start to clarify 
the situation. He is asked to describe in detail what happens when he 
is at home and to imagine what he would do if he were free. What 
emerges is a relationship pattern in which there is no movement into 
intimate contact and no movement to separate while maintaining 
the sense of emotional bonding. This eventually links to early 
childhood experiences of being emotionally isolated within a troubled 
family, with freedom only coming by being away from the warring 
family situation. These isolating defenses were necessary in 
childhood, but subsequent exploration led the patient to discover 
other solutions for himself as an adult. For most schizoids, resistance 
to awareness and contact were necessary for survival in childhood, 
and they often still play a healthy function in adulthood. My advice is 
to treat resistance as just another legitimate feeling state of the 
patient, something for you and the patient to experience, 
understand, identify with, and make clear. It should not be treated 
as something to be gotten rid of. It is necessary to bring together 
the parts of the self that the patient has kept isolated from each 
other. This can be done by bringing the split off parts into the room 
at the same time — the desire and the dread, the active and the 
passive core selves, the attacker and the core self. By bringing into 
awareness both parts of a split self, the parts are clarified and a 
dialectical synthesis or assimilation can begin. Certain techniques, 
such as the gestalt therapy empty chair and two-chair techniques, 
may be helpful, but the techniques are less important than the 
attitude of bringing the separated parts into some kind of internal 
dialogue. With regard to groups, schizoid patients often attend 
regularly and are important to the group process, although they may 
not be very active. They often come to group for a long time and 
may feel ashamed about this. When schizoid patients do work in 
group and even manifest some change, they can become discouraged 
by their own shame over how long it is taking or over how the group 
process is not encouraging them. At such times they need support for 
understanding that it is legitimate for the therapy to take that long. 
This is particularly the case when other group members come and go 
more quickly. If growth is occurring, they need help to see 
themselves as other than defective for still being in group and 
encouragement to stay and continue their work. 

The Course of Therapy 

The schizoid compromise in therapy. 

The schizoid patient is often emotionally neither in nor out of 
therapy, just as he or she is neither in nor out of other relationships. 
In therapy this is accomplished by an infrequent but stable schedule, 
by being present without being intimately connected or allowing 
strong affects, and/ or by being in a group but not working. Schizoid 
patients will often be "untouchable" in the sense of putting up a 
mask or wallor showing other signs of lack of intimacy, defense, 
resistance, or retreat from contact. However, they are usually not 
otherwise controlling or manipulative. These individuals usually focus 
on wanting something fixed or external regulation, on "How do I 
change this?" rules, fix-it approaches, and shoulds (especially for .html[ 16/01/20 13 23:42:38] 

My Daily Struggles: Psychotherapy of Schizoid Process 

other people) rather than on affects, needs, or deeper 
understanding. Expressing emotion is difficult, delayed, or 
restrained, and they often react to narcissistic injury with painful, 
prideful, withdrawal. Isolating is easier for schizoids than feeling 
despair or injury. 

Underlying pattern. 

In the active core self mode the patient longs for love, and the 
therapist becomes the avenue of hope. Since it is difficult for 
schizoid patients to feel desire or need fully, they often show pride 
in renouncing need and shame or fear at becoming aware of need. 
This can take the form of total denial, acknowledging but trivializing, 
or intel lectualizi ng the need without feeling it. These patients 
project hope onto the therapist but then fight it. They are usually 
unaware of this process and continue presenting problems to work 
on while stubbornly fighting. Although the fighting is ostensibly 
about what is being discussed, actually it is about core shame and 
terror. So, how does the therapist know how meaningful the therapy 
and the therapist are to the patient? It usually shows subtly in 
behavior: For example, the patient keeps coming, and if the 
therapist does something that injures the therapeutic relationship, 
the patient reacts, often strongly. However, when the patient does 
become aware of his or her attachment to and need for the 
therapist, the immediate reaction is often anger: "I don't want to 
need you, to depend on you. It makes me so angry!" The schizoid 
patient fears loss through abandonment. "If you really knew what I 
am like . . ." is a frequent comment of schizoid patients, even late in 
therapy. The inner schizoid world is characterized by a constant fear 
of desertion and feelings of being unwanted and unlovable, all of 
which may remain out of awareness until they emerge well into the 
therapy. The fear of abandonment relates to the patient's attitude 
toward his or her own intense hunger, and even if the hunger itself is 
not in awareness, it colors the schizoid patient's adult functioning. 
The schizoid patient wants to ensure the therapist's or lover's 
presence, to "possess" the other. This is most often represented in 
fantasy (e.g., using sadomasochistic symbolism). One aspect of this is 
an antilibidinal attack on the needy self. There is also a disguised 
dependence and or oneness (e.g., bondage can symbolically ensure 
connection or oneness with the significant other). Generally, schizoid 
patients are not demanding or controlling of the therapist, except 
for the isolating defenses. However, it is usually a long time before 
the patient is aware of these underlying processes. No therapist can 
completely satisfy the schizoid patient's intense cravings. When the 
therapist inevitably fails in his or her response, this supports the 
patient's projections that the therapist is intrusive and/ or 
abandoning — or as useless as the patient's parents were in meeting 
needs. This is reinforced even more if the therapist actually is 
controlling, intrusive, or abandoning, which makes the patient's 
perception not entirely inaccurate. This is true regardless of the 
therapist's rationale or good intentions. Even ordinary reflection or 
simple focusing experiments can be controlling or intrusive 
depending on how they are done and how the therapist relates to 
the patient. Schizoid patients often oscillate between hungry eating .html[ 16/01/20 13 23:42:38] 

My Daily Struggles: Psychotherapy of Schizoid Process 

and refusal to eat. This is true both literally and figuratively, 
although more the latter. Mostly they isolate, occasionally 
approaching out of need and then isolating again. This is not 
surprising in light of the basic pattern of approaching in need and 
withdrawing in fear and dread. In the regressed, hidden, passive 
mode, schizoid patients regard others as too dangerous, intrusive, 
devouring, subjugating, and smothering. They want to escape from 
this danger as well as to find security, which leads them to long for 
the womb or temporary death as a relief from an empty outer world 
and an attacking inner world. Relationships are too dangerous, so 
part of the self is kept untouchable even when the patient 
recognizes cognitively what is happening. 

Stages of Therapy 

Ordinary, utilitarian therapy. 

The beginning schizoid patient is often in search of relief of 
symptoms and ways to deal with practical situations. With 
therapeutic support and practical management of life situations 
comes relief and the possibility of either stopping therapy having 
gained some respite or going deeper and working with underlying 

The plateau created by the schizoid compromise. 

At this stage the schizoid patient usually has a vague sense that 
something is missing, that something more in life is possible. 
Sometimes this follows work at the previous stage; sometimes 
patients begin therapy at this stage. There is often resistance to or 
fear of going deeper as well as fear of being more dependent on the 
therapist. The patient usually feels shame at his or her weakness 
and need and fears collapse if the self becomes too weak. Patients 
may stabilize at this stage and feel somewhat better. It is a stage 
characterized by the schizoid compromise, albeit with some 
beginning exploration into the twin fears of being more connected or 
more separate. However, at some point the patient must decide 
whether to stay in therapy and go deeper or leave. This depends in 
large part on how resistance fears are dealt with, how the 
relationship develops, and the supports available to the patient. 
Deeper work begins with the development of the therapeutic 
relationship and as the patient becomes aware of and deals with 
feelings about the therapy itself. If the patient stays with feelings 
and beliefs that arise, the fear and shame are usually too strong to 
support more intimate work immediately. But from the half safety of 
the compromise position, the patient and therapist can develop the 
relationship as well as greater awareness and centering skills. 
Gradually, the fear and shame will decrease enough to go step-by- 
step beneath the plateau. 

Going below the plateau. 

Some patients obtain enough relief by this point and decide to leave 
therapy rather than completing the deeper work. They are left living .html[ 16/01/20 13 23:42:38] 

My Daily Struggles: Psychotherapy of Schizoid Process 

a half-in and half-out life, but perhaps with more comfort, 
connection, and connection while separating. Patients can survive 
here and perhaps even be thought of as leading lives of ordinary 
human unhappiness. Other patients at this stage will "take a break" 
from therapy and plan to return. Going deeper is difficult and time 
consuming. It means reaching the level at which the inner, 
regressed, core material is dealt with and real character 
reorganization can occur. However, even after the fear is relatively 
worked through, the remaining shame requires a tremendous amount 
of work while trust develops and the preverbal, infantile levels of 
the self are worked through. Interpersonal contact and intrapsychic 

At each stage there is a correspondence between the interpersonal 
contact or relationship development between therapist and patient 
and awareness work on the powerful inner needs and terrors this 
contact arouses. The patient usually fears that these needs and 
feelings might be so intense that they will destroy the self and the 
therapist. The patient is also often terrified that his or her ego will 
break down as the self is experienced more fully. The experience of 
no intimate human relatedness and the accompanying experience of 
being utterly alone is understandably terrifying. It is often 
experienced as "black abyss." No one in the schizoid patient's past 
has understood the true, core self. Thus it is not surprising to find 
tenacious resistance at this stage. After all, maintaining bad internal 
objects may well seem preferable to have no internal objects at all. 
This is one reason that deep trust and foundation work must be done 
before deeper working through can be both safe and effective. Two 
related questions arise for the patient at this point: Can the 
therapist be of more use than the patient's parents were, and can 
the patient stand being aware of his or her early, core material? 

Additional Guidelines 


Build support for good boundaries and good contact. Provide a safe 
environment. Watch for the twin dangers of intrusion and 
abandonment. Do not do what the patient experiences as intrusive — 
not even in a good cause. Needless to say, abandonment is not a 
good thing. Be contactful, emotionally direct and open, and 
easygoing. Let the relationship build with time, caring, and 
acceptance. Be inviting but not intrusive. The goal is contact, not 
moving the patient somewhere. Identify and validate the patient's 
experience using empathic reflections. Let it be OK that trust builds 
gradually and that movement is slow. Contact the hidden, isolated 
core self. The patient needs the therapist to contact the patient's 
core self so that he or she can feel like a person. The schizoid 
patient cannot do this for himself or herself. The trick is to do it 
without being intrusive or confrontive. This is done by good contact, 
experiments and reflections, and a steady, inviting presence. 
Cathartic release of emotions is not helpful with the schizoid patient 
unless expressed by the core self. Remember that resistance to 
awareness and contact was necessary for survival and may still be. .html[ 16/01/20 13 23:42:38] 

My Daily Struggles: Psychotherapy of Schizoid Process 

- - ■< : 

Respect it and bring it into awareness as something to be accepted. 
With this awareness comes a choice that the patient did not have 
previously. Work on integrating parts of the self: desire and dread, 
active and passive core selves, internal attacker and core self. In 
group invite participation but allow the schizoid patient to play a 
passive role without being pejorative. Follow the patient's lead about 
timing. If the patient wants to continue and feels ashamed of how 
long it is taking, offer support by acknowledging progress (truthfully 
only), clarifying what is in process and what is next, and normalizing 
the lengthiness (truthfully only). 

Posted by Gary Freedman at 1:21 PM 
Labels: schizoid personality disorder 

M0 t I 


Anonymous said... 

Thanks for the info! 

Wednesday. April 15. 2009 

Anonymous said... 

Thank you for making this available. 

Sunday. October 04. 2009 

Anonymous said... 

I've read a TON of info on schizoid PD and this is by far the 
most informative and scientifically based info I've come across. 
Good work. 

Saturday. November 21. 2009 

Anonymous said... 

Thank you for posting this very understandable, hopeful 

Monday. May 24. 2010 

Anonymous said... 

Stunning. I feel understood. 

Thursday. J une 10. 2010 

Anonymous said... 

Very well done. I relate to ^everything* posted here except 
the early generation of issues, which I can't easily place on my 
parents as we had a very smooth (perhaps too smooth) 
relationship after a very fussy toddlerhood. 

Tuesday. October 19. 2010 

http://dailstrug. .html[ 16/01/20 13 23:42:38] 

My Daily Struggles: Psychotherapy of Schizoid Process 

Anonymous said... 

Thanks, this article is very accurate. Nice to see. I also agree 
with the previous poster, though. The assumption that the 
mother was neglectful/ emotionally cold to schizoid children 
doesn't fit with me. My mother, to the best of my knowledge 
was always there for me in my early years. However, it is 
possible that she was there TOO much for me, perhaps 
smothering me. Actually, I know her well and I could almost 
guarantee this was the case. 

Monday. February 14. 2011 

Anonymous said... 

Thanks. A lot. 

Monday. August 08. 2011 

Anonymous said... 

I'm reading some of your other blogging, and you seem like a 
really smart and interesting person. 

I just wanted to stop a moment to thank you for this particular 
post. You aren't condescending, seeing the schizoid personality 
as something to 'break through.' 

It's easy to undermine or dismiss the fantastasical aspects of 
this mindset, without realizing such fantasies and ideas -are- 
reality for this person, and can be the only things of real value 
or substance in their life. 

Your call for empathy in treatment goes above and beyond 
what I'm used to seeing. I only had a therapist once (under 
outside pressure) and she dropped me for reasons that were 
never divulged. 

But you make me feel like there's some use in trying again, or 
at least hope for others seeking help. 

Friday. September 16. 2011 

Anonymous said... 

This is really good information for me as the wife of someone 
with many of these characteristics. It's very hard not to 
permanently pressurise a schizoid person for contact when 
you're marriedd to them! 

Monday. February 20. 2012 

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